TAHAR ABDULAZIZ MD, PhD
DEFINITION OF PLANT ALKALOID
A basic heterocyclic
nitrogenous compound of
plant origin that are
Deviation from Definition
• Basicity: Some alkaloids are not basic
e.g. Colchicine, Piperine,
• Nitrogen: The nitrogen in some
alkaloids is not in a heterocyclic ring
e.g. Ephedrine, Colchicine, Mescaline.
• Plant Origin: Some alkaloids are
derived from Bacteria, Fungi, Insects,
. castoramine :--- from Canadian beaver
Pyocyanine :-- from Pseudomonas
aeruginosa (a bacteria).
1) True (Typical) alkaloids that are derived from
amino acids and have nitrogen in a heterocyclic
ring. e.g Atropine
2) Protoalkaloids that are derived from amino
acids and do not have nitrogen in a heterocyclic
ring. e.g Ephedrine
3) Pseudo alkaloids that are not derived from
amino acids but have nitrogen in a heterocyclic
ring. e.g Caffeine
4) False alkaloids are non alkaloids give false
positive reaction with alkaloidal reagents.
• They can be found in one or more parts of
the plant (leaves, fruits, seeds, or whole
• Generally, non-soluble in water but can be
extracted by organic solvents in alkaline
• The most important alkaloids of
toxicological interest are: opium, atropine,
cocaine, strychnine, nicotine, aconite,
ergot, digitalis, and cannabis.
A group of narcotic analgesics that
represent one of the most important
groups of CNS depressants.
OPIATES & OPIOIDS
• Opioids exert activity at opioid receptors &
include opioid agonists, antagonists, and
• Opiates are alkaloid extracts of the opium
• Opiates are opioids but the reverse is not
– nociceptin receptor or NOP also known
as the orphanin FQ receptor or kappa-
type 3 opioid receptor
• Minorreceptors (undetermined role in humans)
• About 25 alkaloids are present naturally in
• Opium is the juice taken from the unripe
capsule of poppy plant fruit (Papever
• Poppy plant is present mainly in Asia and
South America, but can be cultivated
anywhere either in hot or cold countries.
• Fresh opium is plastic, moist, smooth, reddish-
brown, then becomes hard, brittle, and dark-
• Dry-ripe poppy capsules contain a trace of
• Poppy seed or Maw seed is
the dried seed of Papaver
• Poppy seeds contain no
significant quantity of
alkaloids contains 50%
• Seed used as food and
• Opium is used for sedative, antitussive, and
• Opium alkaloids are combined with
meconic acid, and divided into 2 groups:
–Hypnotic (depressant) alkaloids:
morphine (10%); codeine (0.5%); narceine
–Convulsant (stimulant) alkaloids:
papaverine (1%); narcotine (6%);
chemically and pharmacologically related to opium:
• Heroin: diacetylmorphine (addictive drug).
• Dionin: ethylmorphine hydrochloride (for corneal
• Apomorphine: central emetic agent.
• Dilaudid: dihydroxymorphine (potent analgesic
with short duration).
• Metopan: methyldilaudid (potent analgesic with
A group of chemically synthesized drugs, which
are remote in chemical structure from that of
opium but have similar pharmacologic effect.
• Pethidine (Meperidine): potent analgesic
usually used as postoperative analgesic and for
• Methadone: potent analgesic usually used to
antagonize withdrawal manifestations during
treatment of heroin and morphine
Pharmacokinetics of opiates:
Well absorbed from GIT, nasal mucosa, pulmonary mucosa, subcutaneous and
Metabolism mainly in liver by conjugation with glucuronic acid, hydrolysis &
Widely distributed into liver, kidneys, lungs, spleen, brain, placenta, intestinal
mucosa, and skeletal muscles.
Excretion mainly by kidneys, where more than 50% are excreted within 8 hours,
about 40% up to 24 hours, and traces are still detectable in urine after 48 hours
by classic methods of detection and for longer periods by sophisticated
Small percentage is excreted in bile, saliva, sweat, & milk.
• Vagal center (slow
full pulse &
• Medullary CTZ
• Sensory cortex
• Cough center
Most opiates are agonists for mu and kappa
• Opiate agonist – antagonist:
– Synthetic drugs have both agonist and antagonist effects i.e.
they oppose the effect of opiates when they are given simultaneously,
but produce similar effects when given alone.
– These drugs are used widely as potent analgesics.
Examples: Pentazocine (Sosegone). Buprenorphine (Norphine).
• Pure opiate antagonist:
– They block all opiate receptors.
– They have reversal effect
– They are used in the treatment of opiate toxicity
Examples: Naloxone (Narcan); Naltroxone.
• Mainly accidental overdose
among addicts or may be
• May be suicidal.
• Rarely homicidal.
• Hot-shoot phenomenon.
• TRIAD (TOXIDROMES):
1- pin-point pupil
2- respiratory depression: slowing or
irregularity of respiratory rate (not on the depth) due to
direct effect on respiratory center.
Clinical Features (cont.)
• Subnormal temperature or even hypothermia.
• Decreased all body secretions except sweating
leading to moist cold skin (cold sweat).
• Rhabdomyolysis: elevated CPK.
• Cardiac conduction defects including LBBB
• Wide QRS (more with propoxyphene).
• Noncardiogenic pulmonary edema, particularly with
heroin, codeine, and methadone overdoses.
• Antidote: Naloxone IV in doses 0.2-4 mg, then
observe for positive response (changes in
respiratory rate & level of consciousness, and size
of pupils). If the response is delayed give more
Naloxone (up to 10 mg) until positive response
• Naloxone plasma half-life (t½) is 30 – 80 minutes
but its effect after IV bolus may last for 10 minutes
only and relapse occurs, so, give repeated doses at
frequent intervals as required.
• Some cases may need IV infusion & NaHCO3
similar to effects in Tricyclic.
HEROIN (Diacetyl Morphine)
• It was synthesized from morphine in 1874, but
become popular after the discovery of Mexican
heroin (black tea) in 1970, which is much more
potent and cheaper than the first one. Heroin can
be taken well absorbed by any route; this is
because of its high lipid solubility.
• Heroin distributes to all tissues and converted to
morphine by hepatic enzymes and it is eliminated
by kidneys as morphine in free and conjugated
Heroin Body Packers Syndrome
• Body Packers (mules)
– Intentional swallowing or
storing the packets in
orifices to smuggle and
– Packets are well prepared
– More quantity
• Body Stuffers
– Hastily conceal illicit
packets in orifices
just prior detection
– Pakets are not well
– Less quantity
• Cocaine is present in the leaves of Erythroxylon coca, which
grows in South America.
• Cocaine is a powerful CNS stimulant and sympathomimetic
agent with local anesthetic effect but chemically related to
• It inhibits reuptake of epinephrine & NE in peripheral ganglia &
increase their secretion centrally
• Its medical use is local anesthetic (paralysis of nerve endings by
blocking fast Na channels)
• Local vasoconstriction (N.B. xylocaine vasodilatation).
Autonomic Effects: tachycardia, hypertension, hyperthermia, tachypnea, mydriasis.
CNS Effects: behavioral and psychiatric disorders such as irritability, hyperactivity,
insomnia, agitation, psychosis (often paranoid), delirium, stupor, seizures, coma.
Heart: sympathetic stimulation of the heart may lead to tachyarrhythmias, myocardial
ischemia, myocarditis, impaired cardiac conduction (local anesthetic effect).
Organ Ischemia: myocardial, renal, and/or intestinal infarction, and limb ischemia.
Shock: hypotension and shock
Pulmonary Effects: pulmonary edema (cardiogenic & noncardiogenic) , adult respiratory
Other Effects: rhabdomyolysis, coagulopathy.
• No specific finding in autopsy, except for nasal
• From the group of hallucinogens
• Psychological & Neurological: affects behavior,
cognition, perception, and performance.
• These effects are dose-dependent.
• Disorientation in time and place.
• Euphoric, talkative, joking and pleased with
himself, may have fear of death and dysphoria.
• Hallucinations , illusions, delusions
• Accentuation of auditory perception.
• Hyperphagia, especially to sweets.
• Marijuana consists of the leaves and
flowering parts of the plant Cannabis sativa
and is usually smoked in cigarettes (“joints”).
• Resin from the plant may be dried and
compressed into blocks called hashish.
• Marijuana contains a number of
cannabinoids; the primary psychoactive one is
THC binds to anandamide receptors
in the brain, may have
effectsdepending on the dose and
time after consumption.
• sedative, or
Nervous disorders such as:
Dilated reactive pupils (with conjunctival
With large doses, the effect varies from mild anxiety to
paranoid behavior to acute psychosis with impaired
complex motor functions.
Cardiovascular: tachycardia with blood pressure changes
and increase in myocardial O2 demand (may be due to
autonomic NS stimulation).
Respiratory: chronic bronchitis, rhinitis, pharyngitis,
horsiness of voice (due to smoking).
• 6 fold increase in schizophrenia
• Mouth, jaw, lung cancers
• Nonlymphoblastic leukemia in
children from mother smokers
• Decreased sperm activity and
change in morphology
Urine Test• THC can be detected 3 – 8 weeks in
chronic users & 3 days in sporadic
• Passive inhalation ± give false-
• False positive: rarely brufen,
• False negative: diuretic use, vinegar
• Anticholinergics are antagonists for the
• Acetylcholine receptors are the muscarinic &
nicotininc receptors in the periphery and
cholinergic receptors centrally.
• Anticholinergics can be natural or synthetic
1- Natural Alkaloids (Tropane Group):
A) Atropa belladonna; atropine
B) Hyoscyamus; hyoscine, hyoscyamine
C) Datura, hyoscine, hyoscyamine,
2- Parmacological Preparations :
a) Tricyclic antidepressants (imipramine).
b) Antipsychotics (phenothiazines, haloperidol)
c) Antihistaminics (chlorephenhydramine).
d) Antiparkinsonism (benzotropine).
e) Antispasmodics (propantheline).
f) Ophthalmic solutions (cyclopentolate).
Hyoscine (scopolamine) differs from
atropine and hyoscyamine in that it has:
Depressant effect from the start.
Milder peripheral action
Toxidrome: Coma + Dry Skin + Hyperthermia +
Cycloplegia + Absence Of Odor
• Diminish of body secretion lead to
• Dry mouth and throat cause hoarseness of voice, thirst and
• Dry skin lead to fever.
• Flushing of skin.
• Dilated fixed pupil leading to blurring of vision, diplopia and
• Rapid pluse due to vagal block. Sinus tachycardia is the most
sensitive sign of toxicity
• Urinary retention and decrease intestinal motility.
Stage of stimulation
• Occupational purposeless movement as (rolling
cigarette, threading needles and catching flies).
• Restlessness, anxiety, talkativeness and free laughing.
Stage of depression
• Patient is drowsy, stupor and gradually become
Coma characterized by :
• Rise in temperature.
• Dry flushed skin.
• Dilated fixed pupil.
• When depression in medulla occur pulse and
respiration become slow weak and irregular.
• Respiratory failure (Central asphyxia).
• It is the main alkaloid
found in the seeds of
Strychnos Nux vomica.
The seeds are hard, flat
biconcave discoid in
shape, 1-2 cm in
and covered with hair
• Mainly accidental
• Fatal dose about 30 mg.
• Fatal period: 2h.
• Absorption through GIT & nasal mucosa.
• After absorption, about half of the dose is
distributed in all tissues in about 5 min.
• Metabolized in the liver.
• 5-20% of dose excreted unchanged in urine
within 24 hrs.
• Action: causes stimulation of the spinal cord,
brainstem, & thalamus by competitive
inhibition of postsynaptic glycine receptors,
which is an inhibitory neurotransmitter in the
generalized fits + Opisthotonus +
Risus sardonicus + Full
Onset of symptoms after 15-30 minutes.
Starting as restlessness, increased visual &
auditory acuity, nausea, vomiting, and
muscle twitching, then sudden onset of
generalized, extremely painful tonic fits
while patient is fully conscious.
Strychnine fits are characterized by:
Generalized tonic convulsions.
Last 0.5-2 min with 10-15 min intervals of complete
relaxation between fits.
Retraction of the jaw gives peculiar complexion
called risus sardonicus (devil's laugh).
Body takes extensor position called opisthotonus.
During fits there may be apnea, bulging of
eyeballs, cyanosis, bloody froth, dilated pupils,
bradycardia, hypertension, hyperthermia, lactic
acidosis, and rhabdomyolysis.
Patient cannot tolerate frequent fits; they die
from exhaustion or asphyxia.
1-Tetanus. 2- Head injury. 3- Meningitis. 4- Epilepsy. 5- Hysteria.
HISTORY Taking food with bitter taste Wound
ONSET Sudden Gradual
Generalized fits with relaxation
Tonic contractions start at
DEATH Rapid (2hrs) Delayed (24 hrs)
DIAGNOSIS Chemical detection Bacterial isolation